Microsoft word - trust formulary (revised 2013) - 10 2013 update

DRUG FORMULARY

Updated after HEY Drug and Therapeutics Committee meeting Of September 2013

This formulary is used and maintained by Hull and East Yorkshire Hospitals NHS Trust.

It is also used as a formulary by Humber Foundation NHS Trust (HFT) and City Health Care Partnership (CHCP).The formulary has been agreed with Hull Clinical Commissioning Group and East Riding of Yorkshire Clinical Commissioning Group with the expectation that providers within Hull and East Riding will prescribe and recommend drug treatments from those listed in the formulary. A joint formulary is currently in development

Guide:

Bold and highlighted = preferred first line agent Italics = specialist recommendation only
Other agents = can still be used, but are not preferred first line agent
Drugs not listed are considered non formulary, and will not be supplied from hospital pharmacy. Non formulary drugs should not be recommended for initiation in primary care. For further information on formulary process, including application for use of additional agents within individual organisations, see contact details below:

Many drugs in chapter 4 are initiated on advice of Mental Health specialists (e.g. HFT) and it is expected that patients may be continued on these or treatment may be initiated on them on advice of a Mental Health specialist 4.1 HYPNOTICS AND ANXIOLYTICS 4.1.1 Hypnotics

Temazepam Loprazolam Continuation of GP initiated treatment onlyContinuation of GP initiated treatment only Clomethiazole (Chlormethiazole) These agents will not normally be supplied on discharge

4.2 DRUGS USED IN PSYCHOSES AND RELATED DISORDERS 4.2.1 Antipsychotic Drugs Amisulpride Mental Health advice or Continuation of treatment only advice or Continuation of treatment only Mental Health advice or Continuation of treatment only Mental Health advice orContinuation of treatment onlyPsychogeriatrician or Mental Health advice / continuation Neurologists or Mental Health advice / continuationMental Health advice or Continuation of treatment only Mental Health advice or Continuation of treatment only Other agents not recommended and only available if recommended by a Mental Health specialist

6.1.2.3 Other Antidiabetics Lixisenatide Specialist use only as per guidelinesSpecialist use only as per guidelines Specialist use only as per guidelines Pioglitazone/metformin (Competact ) Sitagliptin Saxagliptin Dapagliflozin

8.1 CYTOTOXIC DRUGS All items in italics are Specialist Use ONLY, and should only be prescribed by Consultant Oncologist, Haematologist and their teams. Disodium folinate 8.1.1 Alkylating AgentsCyclophosphamide Bendamustine Busulfan Carmustine Carmustine Implant 8.1.2 Cytotoxic AntibioticsBleomycin (Caelyx or Myocet® depending on indication) Doxorubicin and DC beads (for precision TACE) Epirubicin 8.1.3 AntimetabolitesMercaptopurine Methotrexate Capecitabine Cladribine Cytarabine Liposomal Cytarabine Fludarabine Gemcitabine Tioguanine (Thioguanine) Pemetrexed Available on chairs approval in accordance with TA 61 8.1.4 Vinca Alkaloids and etoposide Etoposide Vinblastine Vindesine Vinorelbine 8.1.5 Other Antineoplastic agentsAzacytidine (Vidaza) Amsacrine Bevacizumab Bexarotene PbR excluded. PCT treatment exemption panel approval required Bortezomib Carboplatin Cetuximab Cisplatin Dacarbazine Dasatinib Docetaxel Erlotinib Gefitinib Hydroxycarbamide (Hydroxurea) Imatinib Irinotecan Ipilimumab Nilotinib Paclitaxel Pazopanib Procarbazine Sunitinib Temozolamide Topotecan Trastuzumab Tretinoin Trabectedin Use in line with NICE TA185 & Cancer Network Guidelines Vemurafenib Use in line with NICE TA269 & Cancer Network Guidelines National Cancer Drugs Fund List 2013 Indication Abiraterone
1st line treatment of metastatic castrate resistant prostate cancer (Mcrpc) in adult men who are asymptomatic, or mildly symptomatic, after failure of androgen deprivation therapy (ADT) in whom chemotherapy is not yet clinically indicated
Axitinib
Option for 2nd line advanced renal cell carcinoma with progression after TKI or a cytokine
Bendamustine
2nd or subsequent line treatment of CLL for patients whom fludarabine combination therapy is not a therapeutic option. Treatment of relapsed low grade NHL in patients unable to receive standard chemotherapy. 1st line treatment of low grade non-hodgkins lymphoma in combination with rituximab Treatment of relapsed low grade/indolent NHL refractory to rituximab based regimens 2nd and subsequent line treatment of mantle cell lymphoma in patients who have not received previous bendamustine 1st line treatment of mantle cell lymphoma in combination with rituximab in patients unsuitable for standard first line treatment Treatment of relapsed multiple myeloma where other treatments are not appropriate
Bevacizumab
Treatment of patients with triple negative metastatic breast cancer and/or prior taxane therapy 1st line treatment of metastatic colorectal cancer. Only to be administered concurrently with chemotherapy, not as single agent maintenance therapy. 2nd line treatment of metastatic colorectal cancer in combination with standard chemotherapy in patients who have not previously received bevacizumab. Only to be administered concurrently with chemotherapy, not as single agent maintenance therapy. 3rd line treatment of metastatic colorectal cancer in combination with standard chemotherapy in patients who have not previously received bevacizumab. Only to be administered concurrently with chemotherapy,not as single agent maintenance therapy. 1st line treatment of advanced (stage IIIc/IV) ovarian cancer, sub-optimally debulked either at primary or delayed primary (interval) surgery (including peritoneal and fallopian tube cancer) OR unsuitable for debulking surgery.
Botezomib
Treatment of relapsed or refractory multiple myeloma at second and subsequent relapse in patients who are botezomib naïve and where the patient unable to access bortezomib at first relapse. Treatment of relapsed or refractory multiple myeloma at second and susbsequent relapse in patients with previous good response to bortezomib. Treatment of 2nd or subsequent relapse in Refractory Mantle cell Lymphoma, in patients not fit for transplant Treatment of relapsed Waldenstrom’s macroglobulinaemia after previous treatment with standard chemotherapy
Brentuximab
Treatment of relapsed or refractory Hodgkins lymphoma in patients who have failed at least two prior multi-agent chemotherapy regimens and are not ASCT candidates As a bridge to allograft transplant for the treatment of Hodgkin’s
Lymphoma where no other salvage treatment is available As a bridge to allograft transplant for the treatment of anaplastic large cell lymphoma where no other salvage treatment is available
Cabazitaxel
2nd line treatment of advanced castration resistant prostate cancer following docetaxel based regimen 3rd line treatment of advanced castration resistant prostate cancer following docetaxel and abiraterone based treatment
Cetuximab
1st line treatment of metastatic and/or recurrent squamous cell carcinoma of the head and neck Treatment of KRAS wild-type metastatic colorectal cancer in any indication outside of NICE TA176, in patients who have not previously received cetuximab up to progression
Clofarabine
Acute myeloblastic leukaemia in patients with relapsed/refractory disease in whom the intent is to use treatment as a bridge to bone marrow transplantation Acute lymphoblastic leukaemia in patients with relapsed/refractory disease in whom the intent is to use treatment as a bridge to bone marrow transplantation
Crizotinib
In second and subsequent line anaplastic lymphoma kinase (ALK) – positive advanced non -small lung cancer
Dasatinib
Treatment of adults with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukaemia (ALL) with resistance or intolerance to prior therapy including Imatinib Treatment of adults with Philadelphia chromosome positive (Ph+) lymphoid blast CML with resistance or intolerance to prior therapy including Imatinib 2nd line treatment of chronic, accelerated or blast phase CML patients with intolerance to imatinib mesilate, and who are intolerant of nilotinib
Eribulin
Treatment of patients with locally advanced or metastatic breast cancer who have been previously treated with (or unsuitable for ) an anthracycline, a taxane and capecitabine
Everolimus
2nd line treatment of metastatic renal cell carcinoma where disease has progressed on or after treatment with VEGF- targeted therapy or where patient has a contra-indication to or is intolerant of VEGF –targeted therapy 1st line treatment of unresectable or metastatic, well- or moderately-differentiated neuroendocrine tumours of pancreatic origin in adults with progressive disease 2nd line treatment of unresectable or metastatic, well-or moderately-differentiated neuroendocrine tumours of pancreatic origin in adults with progressive disease 2nd line treatment of hormone receptor +ve, HER2 negative advanced breast cancer, in combination with exemestane, in post menopausal women without symptomatic visceral disease after recurrence or progression following a non steroidal aromatase inhibitor who have not received previous exemestane
Imatinib
Adjuvant treatment of gastro-intestinal stromal tumours (GIST), in patients considered high risk of relapse (based on risk criteria or mutation analysis), for up to 3 years
Lapatinib
2nd and subsequent line use in combination with capecitabine for the treatment of patients with locally recurrent or metastatic breast cancer, whose tumours over express HER2(ErbB2) and whose disease has progressed on trastuzumab
Lenalidomide
2nd line treatment of multiple myeloma in patients who have contraindications to the use of bortezomib
Nelarabine
Treatment of refractory T-cell lymphoblastic non-Hodgkin’s Lymphoma as a bridge to bone marrow transplantation Treatment of refractory T-cell acute lymphoblastic leukaemia as a bridge to bone marrow transplantation
Ofatumumab
2nd line treatment of chronic lymphocytic leukaemia (CLL) in patients who are refractory to fludarabine and ineligible/unsuitable for alemtuzumab 2nd line treatment of CLL in patients with p53 mutation who relapse or progress on first line alemtuzumab and are not suitable for fludarabine 3rd line treatment of CLL in patients refractory to fludarabine and alemtuzumab
Pazoponib
Third line treatment of metastatic non-adipocytic soft tissue sarcoma
Pegylated Liposomal
1st line treatment of angiosarcoma, especially cutaneous
Doxorubicin (Caelyx)
2nd line treatment of angiosarcoma, especially cutaneous 1st line treatment of primary sarcoma of the heart and great vessels 1st line treatment of sarcoma in patients with cardiac impairment who need an anthracycline 2nd line treatment of sarcoma in patients with cardiac impairment who need an anthracycline 2nd line treatment of fibromatosis
Pemetrexed
2nd line treatment of patients with locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology in patients who did not receive 1st line pemetrexed e.g. 1st line clinical trial Maintenance treatment of stage IIIB/IV non-squamous non-small cell lung cancer after response to pemetrexed-containing first line therapy
Peptide receptor
Treatment of advanced neuroendocrine tumours i.e. for pNETS
Radionucleotide Therapy
after sunitinib/Chemotherapy, For mid-gut Carcinoid, after
to include Lutetium 177 Octreotate or Yttrium90 octreotide/octreotate Ruxolitinib
1st line treatment of symptomatic splenomegaly in adult patients with primary myelfibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis. For new patients only 2nd line treatment of symptomatic splenomgaly in adult patients with primary myelfibrosis, post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis. For new patients only
Sorafenib
1st line treatment of advanced hepatocellular carcinoma in patients with Childs A disease 1st line treatment of advanced hepatocellular carcinoma in patients with low disease burden Childs B disease Treatment of papillary or follicular thyroid cancer that is inoperable or metastatic disease that is refractory to radioiodine
Sunitinib
1st line treatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumour with disease progression 2nd line treatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumour with disease progression 3rd line treatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumour with disease progression
Temsirolimus
1st line treatment of patients with advanced renal cell carcinoma
(RCC) who have at least three of six prognostic risk factors.
Vandetinib
Treatment of symptomatic, locally advanced (unresectable) or metastatic medullary thyroid cancer.

11.9 CONTACT LENS PREPARATIONS These products are not prescribable under the NHS, unless special exemption is obtained. Various preparations are available for sale. CHAPTER 12: EAR, NOSE, AND OROPHARYNX AS PER BNF, CERTAIN PRODUCTS ARE LICENSED/APPROVED FOR BOTH AURAL AND OCULAR USE. See BNF section 11 for more detail.

For guidance on the choice and use of vaccines, see ‘Immunisation against infectious diseases’ a HMSO publication – available online at: http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254

Gadoteridol (Prohance ) Radiology Gadoxetic For use in breast reconstruction only. FORMULARY APPENDIX 2 – DRUGS RECOMMENDED IN NICE TA WHICH ARE NOT IN FORMULARY NICE TA EXPLANATION
Renal transplant operations are not performed by
Renal transplant operations are not performed by
Immunosuppressive Regimens for Children and
Adolescents TA 235 Osteosarcoma - Mifamurtide
Recommended for treatment in specified children, adolescents and young adults. This cohort of patients are referred to specialist provider.
TA 282 Pirfenidone for treating idiopathic

This information is intended for U.S. residents only. DEPAKOTE® Sprinkle Capsules DIVALPROEX SODIUM COATED PARTICLES IN CAPSULES BOX WARNING: HEPATOTOXICITY: HEPATIC FAILURE RESULTING IN FATALITIES HAS OCCURRED IN PATIENTS RECEIVING VALPROIC ACID AND ITS DERIVATIVES. EXPERIENCE HAS INDICATED THAT CHILDREN UNDER THE AGE OF TWO YEARS ARE AT A CONSIDERABLY INCREASED RISK OF DEVELOPING FATAL